DOCSLIB.ORG

Simultaneous Occurrence of Chicken Pox and Herpes Zoster with Facial Nerve Palsy in Immunocompetentpatient- a Case Report

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Simultaneous Occurrence of Chicken Pox and Herpes Zoster with Facial Nerve Palsy in Immunocompetentpatient- a Case Report Case Report J Cardiol & Cardiovasc Ther Volume 11 Issue 4 - August 2018 Copyright © All rights are reserved by Basumatary LJ DOI: 10.19080/JOCCT.2018.11.555816 Simultaneous Occurrence of Chicken Pox and Herpes Zoster with Facial Nerve Palsy in ImmunocompetentPatient- A Case Report Basumatary LJ1* and Lalit MB2 1Consultant Neurologist, Downtown Hospitals, India 2Department of Neurology, Downtown Hospitals, India Submission: May 10, 2018; Published: August 06, 2018 *Corresponding author: Basumatary LJ, Consultant Neurologist, Downtown Hospitals, India, Email: Abstract Herpes zoster is caused by reactivation of the latent varicella zoster virus which is present due to an earlier varicella infection. The prodromal stage, the only presenting symptom may be odontalgia, which may prove to be a diagnostic challenge, since many diseases can cause simultaneous occurrence of herpes zoster and varicella zoster in the same patient is sufficiently uncommon to warrant notice. During the division of right trigeminal nerve masquerading as odontalgia with simultaneous occurrence of varicella zoster and right facial nerve palsy. or facial pain, and the diagnosis must be properly established before final treatment. Here we present a case of herpes zoster involving the second Keywords: Herpes zoster; Chicken-pox; Varicella zoster virus; Simultaneous occurrence of chicken pox and herpes zoster; Odontalgia Introduction Herpes Zoster (HZ) occurs as a reactivation of Varicella Zoster Case Report Virus (VZV) that remains latent in dorsal sensory nerve root 48 year old male non diabetic non hypertensive developed ganglion after primary varicella infection (chicken-pox). Bokay papulo-vesicular rashes over right side of face, toothache and fever. He approached to a local dentist and was advised to take co- & HZ. Since his observation, many such cases have appeared in amoxiclav and analgesics. As there was no improvement moreover [1] was the first to note the association of Varicella Zoster (VZ) the medical press in which varicella had developed in susceptible rashes spread along the right maxillary nerves (V2) and the right individuals when exposed to HZ and vice versa. Ferryman [2] half of the palate, he presented to us and admitted on the 5th day reviewed about 100 cases, and concluded that this combination of rashes. Lesions were painful, burning in nature, non-pruritic of diseases was common in the elderly men; and that varicella and associated with watering & redness of right eye. Typical chicken-pox lesions were also present all over the torso and both the literature to date, and described three cases. He stated that upper limbs, sparsely over lower limbs. He had no past history followed herpes zoster within five days. Campbell [3] reviewed in all his cases an attack of unilateral HZ was followed by the of chickenpox; his sister-in-law (1st level contact) also developed chicken pox after a few days. He developed right sided peripheral facial nerve palsy during the course of the disease. Other cranial development of a varicella rash at interval of five to seven days. by VZ. Sukhala [5] also reported such unusual case of simultaneous nerve examination was found normal. There were no vesicles John Almeyda [4] also reported 3 such cases in which HZ followed occurrence of HZ ophthalmic us involving the ophthalmic and or other form of eruption in the auricular zone. The tympanic maxillary division of trigeminal nerve followed two days later by membrane, external auditory canal and meatus, concha, tragus, the generalized chicken pox. Chava [6], published a case series antitragus, helix and fossa, and posterior surface of the lobe of the in which he described HZ may arise as precede to VZ as in the ear were entirely normal. There was no earache throughout the case of 85 year old male patient, who never had varicella or zoster course of the illness. developed HZ of all three trigeminal branches of left side with Clinical examination superinfection of staph aurous and proteus species and typical varicella rash with lesions on the buccal mucosa and fauces. Febrile (temp 102.6 °F), Pulse-92bpm, BP-120/90mm of Hg, no P/I/C/Cy/O, S/E- NAD. J Cardiol & Cardiovasc Ther 11(4): JOCCT.MS.ID.555816 (2018) 001 Journal of Cardiology & Cardiovascular Therapy Investigation varicella rash all over the body in immune competent patient is extremely uncommon and to my knowledge not yet reported. Conclusion RBS-116mg/dl, s. Na₊-132.6mEq/L, s. K₊ 4.72mEq/L, Hb- 1/2 non-reactive, Liver function test-within normal limits, swab 12.3gm%, TC-6000/cu mm, P-63, L-25, M-10, E-02, ESR-15, HIV- In conclusion, a case of HZ affecting the second division of from right side face lesions- staphylococcus aureus. Tzank smear the trigeminal nerve is reported along with facial nerve palsy and from vesicles found to be positive. Varicella- Zoster IgG antibody simultaneous occurrence of chicken-pox in immune competent was positive and IgM was negative sent on 10th day of fever. patient. This case highlights the importance of a thorough dental Diagnosis and treatment history and examination in patients with odontalgia. Those cases presenting with atypical odontalgia, HZ should be considered in the differential diagnosis. Furthermore, clinicians should be aware laboratory reports as the simultaneous occurrence of HZ of second Diagnosis was made on the basis of history, clinical profile and of atypical presentation of VZV. Clinicians are urged to recognize division of trigeminal nerve & VZ with superadded secondary the early features of HZ and to provide prompt antiviral therapy to infection of staphylococcus aureus and peripheral facial nerve prevent the complications. palsy. He was managed over tab valcyclovir, tab gabapentin, IV ceftriaxone, acyclovir ointment for both eye and skin lesions. References He improved satisfactorily and then discharged. On subsequent 1. Bokay V (1892) Quoted by John Alymeda (1942) Post Graduate Medical follow up his skin lesions healed by crusting, but painful sensation and paresthesia over right maxillary nerve distribution persisted. 2. Journal 18(203): 175-177. On subsequent follow-up facial palsy improved completely. Ferriman DG (1939) Multidermatomal herpes zoster in an Discussion immunocompromised patient-A case report. Lancet 1: 930. 4. Almeyda J (1942) Simultaneous occurrence of herpes zoster and The majority of HZ infections involve the thoracic and 3. Campbell RM (1941) Brit J Child Dis 38: 91-98. 5. present with infections involving any of the three branches of varicella. Postgrad Med J 18(203): 175-177. lumbar dermatomes; however, approximately 13% of patients followed by varicella in a young adult. Indian Journal of Ophthalmol the trigeminal nerve. The ophthalmic branch is most commonly Shukla IM, Tiwari SK, Billore OP (1973) Herpes zoster ophthalmic us affected; however, in our case only the maxillary branch is 6. 21(3): 131-133. nerve palsy with trigeminal nerve HZ is even rarer, one such case Chava ER (1961) Complications of chicken-pox. Br Med J 1(5230): 944- involved; this is rare (1.7% of cases) [7]. Occurrence of the facial 947. reported by John D Spillane. But the simultaneous occurrence Population based study of herpes zoster and its sequelae. Medicine of the facial nerve palsy after maxillary nerve HZ with a typical 7. (Baltimore)Ragozziuo MW, Melton LJ, Kudand LT, Chu CP, Perry HO (1982) 61(5): 310-316. This work is licensed under Creative Your next submission with Juniper Publishers Commons Attribution 4.0 License DOI: 10.19080/JOCCT.2018.11.555816 will reach you the below assets • Quality Editorial service • Swift Peer Review • Reprints availability • E-prints Service • Manuscript Podcast for convenient understanding • Global attainment for your research • Manuscript accessibility in different formats ( Pdf, E-pub, Full Text, Audio) • Unceasing customer service Track the below URL for one-step submission https://juniperpublishers.com/online-submission.php How to cite this article: Basumatary LJ, Lalit MB. Simultaneous Occurrence of Chicken Pox and Herpes Zoster with Facial Nerve Palsy in ImmunocompetentPatient- 002 A Case Report. J Cardiol & Cardiovasc Ther. 2018; 11(4): 555816. DOI: 10.19080/JOCCT.2018.11.555816.
Load more

Recommended publications
  • My Tooth Hurts: Your Guide to Feeling Better Fast by Dr
    Copyright © 2017 by Dr. Scott Shamblott All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means—including electronic, mechanical, photocopying, recording, or otherwise—without the prior written permission of Dental Education Press, except for brief quotations or critical reviews. For more information, call 952-935-5599. Dental Education Press, Shamblott Family Dentistry, and Dr. Shamblott do not have control over or assume responsibility for third-party websites and their content. At the time of this book’s publication, all facts and figures cited are the most current available, as are all costs and cost estimates. Keep in mind that these costs and cost estimates may vary depending on your dentist, your location, and your dental insurance coverage. All stories are those of real people and are shared with permission, although some names have been changed to protect patient privacy. All telephone numbers, addresses, and website addresses are accurate and active; all publications, organizations, websites, and other resources exist as described in the book. While the information in this book is accurate and up to date, it is general in nature and should not be considered as medical or dental advice or as a replacement for advice from a dental professional. Please consult a dental professional before deciding on a course of action. Printed in the United States of America. Dental Education Press, LLC 33 10th Avenue South, Suite 250 Hopkins, MN 55343 952-935-5599 Help! My Tooth Hurts: Your Guide to Feeling Better Fast by Dr.
    [Show full text]
  • Third Molar (Wisdom) Teeth
    Third molar (wisdom) teeth This information leaflet is for patients who may need to have their third molar (wisdom) teeth removed. It explains why they may need to be removed, what is involved and any risks or complications that there may be. Please take the opportunity to read this leaflet before seeing the surgeon for consultation. The surgeon will explain what treatment is required for you and how these issues may affect you. They will also answer any of your questions. What are wisdom teeth? Third molar (wisdom) teeth are the last teeth to erupt into the mouth. People will normally develop four wisdom teeth: two on each side of the mouth, one on the bottom jaw and one on the top jaw. These would normally erupt between the ages of 18-24 years. Some people can develop less than four wisdom teeth and, occasionally, others can develop more than four. A wisdom tooth can fail to erupt properly into the mouth and can become stuck, either under the gum, or as it pushes through the gum – this is referred to as an impacted wisdom tooth. Sometimes the wisdom tooth will not become impacted and will erupt and function normally. Both impacted and non-impacted wisdom teeth can cause problems for people. Some of these problems can cause symptoms such as pain & swelling, however other wisdom teeth may have no symptoms at all but will still cause problems in the mouth. People often develop problems soon after their wisdom teeth erupt but others may not cause problems until later on in life.
    [Show full text]
  • Would You Go to Your PCP for a Toothache? He Or She Is Trained in All Aspects of the Human Body and Has a Good Understanding of the Teeth and Gums
    WOULD YOU GO TO YOUR PCP FOR A TOOTHACHE? I pose the question, "Would you go to your PCP for a toothache? He or she is trained in all aspects of the human body and has a good understanding of the teeth and gums. He or she knows that healthy teeth play an important part in overall health, so certainly one would think that going to him or her might be a good option. But you don't. Why not? Well, because we all know that a dentist has more specific training, knowledge and experience with teeth and related matters. In fact, even if you did go to your PCP, I bet 99.99% or more would send you to your dentist, and you would thank them and do so without hesitation. This Photo by Unknown Author is licensed under CC BY-NC-ND So, who should you see if you are having musculoskeletal problems? To this day about 86% of people would select their primary physician or equivalent medical practice for these issues. Is that any smarter than seeing him or her for your teeth? Studies in 2004, 2006 and 2007 found that not only were the areas of spinal dysfunction and mechanical back pain not understood by the medical doctors, but most had little if any training in the area and almost no experience treating it. The typical response to treating low back pain is still to provide pain medication, muscle relaxants, order an x-ray and possibly refer to physical therapy. This is the routine in spite of the 1994 U.S.
    [Show full text]
  • Transcutaneous Electrical Nerve Stimulation for Acute Pain (Review)
    Transcutaneous electrical nerve stimulation for acute pain (Review) Walsh DM, Howe TE, Johnson MI, Moran F, Sluka KA This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2011, Issue 8 http://www.thecochranelibrary.com Transcutaneous electrical nerve stimulation for acute pain (Review) Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 BACKGROUND .................................... 2 OBJECTIVES ..................................... 3 METHODS ...................................... 3 RESULTS....................................... 6 Figure1. ..................................... 9 Figure2. ..................................... 10 DISCUSSION ..................................... 13 AUTHORS’CONCLUSIONS . 14 ACKNOWLEDGEMENTS . 14 REFERENCES ..................................... 15 CHARACTERISTICSOFSTUDIES . 19 DATAANDANALYSES. 49 Analysis 1.1. Comparison 1 TENS versus placebo TENS, Outcome 1 VAS >50% pain relief post treatment. 50 Analysis 1.2. Comparison 1 TENS versus placebo TENS, Outcome 2 Pain rating index >50% pain relief post treatment. 51 Analysis 1.3. Comparison 1 TENS versus placebo TENS, Outcome 3 VAS for pain intensity after two days of treatment. 51 Analysis 1.4. Comparison 1 TENS versus placebo TENS, Outcome 4 Numerical rating scale for pain intensity during procedure...................................
    [Show full text]
  • Clinical Diagnosis of Herpes Zoster Presenting As Odontogenic Pain
    대한치과보존학회지: Vol. 33, No. 5, 2008 Clinical Diagnosis of Herpes Zoster Presenting as Odontogenic Pain Seong-Hak Yang, Dong-Ho Jung, Hae-Doo Lee, Yoon Lee, Hoon-Sang Chang, Kyung-San Min* Department of Conservative Dentistry, College of Dentistry, Wonkwang University ABSTRACT Herpes zoster, an acute viral infection produced by the varicella zoster virus, may affect any of the trigeminal branches. This case report presents a patient with symptoms mimicking odontogenic pain. No obvious cause of the symptoms could be found based on clinical and radiographic examinations. After a dermatologist made a diagnosis of herpes zoster involving the third trigeminal branch, the patient was given antiviral therapy. Two months later, the facial lesions and pain had almost disap- peared, and residual pigmented scars were present. During the diagnostic process, clinicians should keep in mind the possibility that orofacial pain might be related to herpes zoster. [J Kor Acad Cons Dent 33(5):452-456, 2008] Key words : Herpes zoster, Trigeminal nerve, Odontogenic pain - Received 2008.7.2., revised 2008.8.4., accepted 2008.8.25- Ⅰ. INTRODUCTION affected by the reactivation of the latent herpes zoster virus the most. The first division of the Diagnostic assessment in patients with orofacial trigeminal nerve is commonly affected, whereas pain may be challenging due to the close proximi- the second and third divisions are rarely ty between the teeth and other orofacial tissues, involved4). If the third division of the trigeminal and symptoms associated with neurological disor- nerve is affected, it may be characterized by pul- ders. Herpes zoster (shingles) is caused by the pitis in the mandibular molars and vesicular skin reactivation of the latent varicella-zoster virus eruptions in the affected sensory nerve area.
    [Show full text]
  • Acute Low Back Pain
    Acute low back pain Key reviewers: Mr Chris Hoffman, Orthopaedic Surgeon, Mana Orthopaedics, Wellington Dr John MacVicar, Medical Director, Southern Rehab, Christchurch Key concepts: ■ Acute low back pain is common and most patients will recover fully within three months ■ Serious causes are rare and can be excluded with careful history and examination ■ Radiological studies are not required for acute low back pain in the absence of red flags ■ An exact diagnosis is often not possible, nor needed for management ■ Patients’ beliefs and attitudes warrant as much attention as the anatomical and pathological aspects of their condition ■ Fear about pain is a major determinant of disability and possible chronicity ■ Management should include reassurance, education and helping the patient stay active ■ Adequate analgesia is important to allow the patient www.bpac.org.nz keyword: lowbackpain to stay active 6 | BPJ | Issue 21 Acute low back pain is common and often relapsing Red Flags: ▪ Trauma Low back pain is discomfort, muscle tension or stiffness ▪ Unrelenting pain, or pain worse at night localised to the area around the lumbar spine. Back pain (supine) may radiate to the groin, buttocks or legs as referred somatic pain and may be associated with lumbar radicular ▪ Age <20 years, or new back pain age >50 pain such as sciatica. years ▪ History of cancer In any given year approximately one third of adults will ▪ Systemic symptoms suffer from low back pain and one third of these will seek help from a health practitioner.1 Most people with low ▪ IV drug use back pain self-treat with over-the-counter medications and ▪ Immunosuppression or steroids lifestyle changes.2 ▪ Widespread or progressive neurological deficit Low back pain is described as acute if present for less than six weeks, sub-acute between six weeks and three Serious causes of acute low back pain are rare months, and chronic if it continues for longer than three and include:6 months.
    [Show full text]
  • Common Emergencies
    ADVICE SHEET WHAT TO DO IF YOU HAVE TOOTHACHE PAIN SYMPTOMS: ✅ Comes on when eating or drinking ✅ Lasts seconds or minutes ✅ Not disturbing sleep ✅ Can be relieved by painkillers ✅ Difficult to localise to one specific tooth [email protected] 0141 779 9274 8 Station Road, Muirhead www.hannigandentalcare.co.uk Glasgow, G69 9EE Page 1 of 6 ADVICE: WHAT TO DO IF YOU HAVE TOOTHACHE Sensitivity/Reversible Toothache PAIN SYMPTOMS: ✅ Comes on when eating or drinking ✅ Lasts seconds or minutes ✅ Not disturbing sleep ✅ Can be relieved by painkillers ✅ Difficult to localise to one specific tooth If this sounds like the type of pain you are experiencing then it is likely you are suffering from sensitivity. This is usually relieved with the use of a desensitising toothpaste, e.g. Sensodyne Rapid Relief. You should use a desensitising toothpaste every morning and night; place it on to a dry toothbrush and brush round – do not rinse out with water or mouthwash afterwards and do not have anything to drink for 30 minutes afterwards. Each time you use these toothpastes they form a microscopic layer on the teeth; with each use this barrier layer gets thicker and thus more effective at insulating the tooth from the hot/cold, so it takes about 2 weeks before it’s working at its optimum. If you are going to have e.g. a cold drink you can rub some directly on to the sensitive tooth with your finger for a minute beforehand and this should help to desensitise it. If you stop using these toothpastes the protective layer will eventually get washed away and your sensitivity will return.
    [Show full text]
  • Tooth Chart of Meridians
    https://dailyhealthpost.com/meridian-tooth-chart/ An Easy-To-Understand Tooth Chart of Meridians Given the connection between teeth health and wellness in other parts of your body, following are some maladies that have been associated with certain teeth (4). A toothache doesn’t necessarily mean that there is a problem elsewhere; however, it is a possibility to explore, especially if discomfort lingers. Here are a few meridians that connect to your teeth: • Incisors and canine teeth are on meridians that connect to the kidney, liver, and gallbladder. • The meridians from bicuspids and molars are to the large intestine and stomach. These meridians link various organs, glands, muscles, and joints to your teeth: • Pain in the upper and lower incisors can indicate kidney, bladder, and ear infections. They may also signal problems with the lymphatic system and reproductive organs. • Molar pain can indicate anemia, stomach and intestinal ulcers, chronic gastritis (inflammation of the stomach lining), hemorrhoids, bladder infections, breast health, rheumatism, and chronic inflammation of the pancreas. • Wisdom teeth, on the other hand, connect to the central nervous system, heart, liver, and intestines. They can also signal high blood pressure, eczema, headache, liver disease, pain in the extremities, and cardiovascular disease. Specific Illnesses The connections above can be further refined to a particular tooth and illness: • Pain in the first incisor can be a sign of a prostate or tonsil infection. • Chronic pain in the canine teeth can be a sign of inflammation of the liver or gallbladder (hepatitis or cholecystitis). • Bicuspid (premolar) teeth can ache as the result of an allergic reaction, intestinal flora imbalance (dysbacteriosis), pneumonia, or colitis.
    [Show full text]
  • Do You Suffer From? Low Back Pain and Chiropractic
    Do You Suffer From? Low Back Pain and Chiropractic Low back pain is one of the most common complaints among chiropractic patients, and also among the top reasons for missed work in the United States. In fact, 75 to 85 percent of all people will experience some form of back pain during their lifetime. Common causes of low back pain include problems with the facet and sacroiliac joints, as well as disc problems. Chiropractic care can be a conservative treatment for all of these. If the low back pain is a problem with the facet joints or the sacroiliac joints it is considered a mechanical low back pain. However, if the problem is disc related, it is considered discogenic low back pain. The more common problem is the mechanical low back pain. This is due to the spine being out of the proper alignment or position. As chiropractors, we call this misalignment a subluxation. Often times when the spine is subluxated, there is pressure on the nerves in the low back which cause the low back muscles and ligaments to become tight or go into spasm. This is a lumbar spine sprain or lumbar spine strain. Chiropractors can use gentle adjustments to begin realigning the spine and take pressure off of the nerves that travel to the muscles in the low back. Over time, each adjustments builds on the previous and the correct posture begins to return. We will usually recommend a low back spinal supports to aid in the recovery process for as well. A lumbar spinal support will help maintain the proper posture as well as provide you with home exercises to do at home.
    [Show full text]
  • Pain: Current Understanding of Assessment, Management, and Treatments
    Pain: Current Understanding of Assessment, Management, and Treatments NATIONAL PHARMACEUTICAL COUNCIL, INC This monograph was developed by NPC as part of a collaborative project with JCAHO. December 2001 DISCLAIMER: This monograph was developed by the National Pharmaceutical Council (NPC) for which it is solely responsible. Another monograph relat- ed to measuring and improving performance in pain management was developed by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) for which it is solely responsible. The two monographs were produced under a collaborative project between NPC and JCAHO and are jointly dis- tributed. The goal of the collaborative project is to improve the quality of pain management in health care organizations. This monograph is designed for informational purposes only and is not intended as a substitute for medical or professional advice. Readers are urged to consult a qualified health care professional before making decisions on any specific matter, particularly if it involves clinical practice. The inclusion of any reference in this monograph should not be construed as an endorsement of any of the treatments, programs or other information discussed therein. NPC has worked to ensure that this monograph contains useful information, but this monograph is not intended as a comprehensive source of all relevant information. In addi- tion, because the information contain herein is derived from many sources, NPC cannot guarantee that the information is completely accurate or error free. NPC is not responsible for any claims or losses arising from the use of, or from any errors or omissions in, this monograph. Editorial Advisory Board Patricia H. Berry, PhD, APRN, BC, CHPN Jeffrey A.
    [Show full text]
  • Featured Folklore – Toothache Cures
    Featured folklore – Toothache Cures Charms and folk remedies to heal an aching tooth appear regularly in the folklore of dentistry. One frequently recorded cure for toothache is to perform a ritual intended to transfer the pain of your aching tooth to another object – often a tree or rock, a nail, the ground, or even another person! The rituals range from simple techniques – one such remedy states “in order to cure toothache cut your finger nails on Friday”1 – to more complex and exacting prescriptions. In his 1926 article The Folklore of the Teeth (IX): The Transference of Toothache, Leo Kanner cites the following toothache cure from Brandenburg, Germany: “One takes a mouthful of salt and goes with it in the evening silently, without greeting or addressing anyone, to the churchyard. There one makes a small hole over the last grave, crosses two blades of straw over the hole and spits the salt upon it. Then the hole is closed with mud, and the patient goes back home as silently as he came. The toothache will disappear and never come back again.”2 The requirement that such rituals be performed ‘in silence’ or ‘without being seen’ recurs in many similar cures. Joseph Carter, in Folk Dentistry: Cultural Evolution of Folk Remedies for Toothache, suggests that this Figure 1 – illustration from Cottrell & Company promotional requirement for secrecy is based upon an ancient belief that words and leaflet, ‘Dental Folklore,’ sight hold power, and words spoken at the wrong time have the power promoting Acrylucent acrylic to break a spell.3 Alternatively, B.R.
    [Show full text]
  • About Pain and Its Treatment in Paraplegics
    Paraplegia IS (1977-78) 349-352 ABOUT PAIN AND ITS TREATMENT IN PARAPLEGICS By M. MAURY, M.D. Centre de Reeducation Motrice, 77 30I Fontainebleau, France Abstract. Apart from pains by removal of inhibition, there are pains by hyperstimulation as well, even with apparently complete paraplegia. Successively, the author first reviews specific sub-lesional pains, then lesional pains (some of them are probably due to deafferentation), and at last, supra-lesional pains which are the most numerous ones and for which examples of hyperstimulation are given. The therapeutic rules used by the author are enumerated. To ease their suffering about 8 per cent of the patients are given antidepressive drugs, which most of the time can be gradually stopped after several months. Key words: Pains; therapeutic approach. OWING to the neuro-physiologists, we know there are two kinds of pains, the ordinary physiological ones by hyperstimulation, and the neurological ones by removal of the inhibition, and it would be tempting to notice only neurological pains in paraplegics. We believe this would be a mistake since not only is there incomplete paraplegia but also we have no way of knowing whether in a so-called total paraplegia there are still possible connections between the peripheral receptors and the brain. Even after a very complete neurological examination, reviewing every sensitiveness on the whole sub-lesional territory, it is absolutely certain we can never maintain we have reviewed every possible stimuli, in their quality, intens­ ity and localization. To find a cause may have some effect upon the treatment. According to their topography, the paraplegic's pains can be classified in three categories: sub-Iesional, lesional and supra-lesional categories.
    [Show full text]